MEDICARE: HERLENA PAMELA LEGGINS MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1285197087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERLENA PAMELA LEGGINS MED

Provider Business Mailing Address
First Line	:	4133 SPRINGLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5109
Country	:	US
Telephone Number	:	405-470-1121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 SPRINGLAKE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5109
Country	:	US
Telephone Number	:	405-740-1121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/09/2019

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Directions to “ HERLENA PAMELA LEGGINS MED” Practice Location

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